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Press Briefing Transcript

OPERATOR: Welcome and thank you for standing by. At this time all participants are a listen-only mode. After the presentation there will be a question andanswersession. To ask a question at that time press star-1. Unmute your phone when prompted. Today's conference is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the call over to Miss --- Dr. Katherine Lyon Daniel. Go ahead. You may begin.

KATHERINE LYON DANIEL: Thank you and good afternoon. My name is Katherine lion Daniel, Communication Director at CDC. Thank you for joining us today for this media briefing on MERS Cov-V including information on the second case of MERS reported in the United States. I'm joined today by the director of the centers for disease control and prevention, Dr. Tom Frieden, F-R-I-E-D-E-N, and Dr. Anne Schuchat, S-C-H-U-C-H-A-T, Director of CDC's National Center for Immunization and Respiratory Diseases. As well as we're joined by Dr. John Armstrong, Florida's state surgeon general and secretary of health. Drs. Frieden, Schuchat and Armstrong will read their prepared remarks and then get to as many of your questions as possible. Please remember to state your name clearly and identify your media outlet. You're allowed one question and one follow-up if needed and then move on to the next question. I'll now turn it over to Dr. Tom Frieden.

TOM FRIEDEN: Thank you very much and thank everyone for joining us today. Today we are announcing the unwelcome but not unexpected news of a second imported case of Middle East respiratory syndrome Coronavirus, or MERS, in the United States. The patient is a health care provider who resides and works in Saudi Arabia where we know there have been clusters of MERS occurring. On May 1st, the patient traveled from Saudi Arabia to Florida. On May 8th, the patient went to the emergency department of a Florida hospital and was admitted on the same day. The patient is isolated in the hospital and is doing well. The Florida public health laboratory tested specimens from the patient using MERS Coronavirus test kits developed by CDC. And last night CDC confirmed the test results in our own laboratory here in Atlanta. Before I turn the call over to Drs. Schuchat and Armstrong for more information, I wanted to help put this in perspective in terms of what an additional case means to the U.S. At CDC we work 24/7 to help protect the security of the country. MERS first emerged in the Middle East about two years ago, and we've been working at CDC very actively with global partners to better understand the nature of the virus, including how it affects people and how it spreads. We have anticipated MERS reaching the U.S., and we prepared for and are taking quick action. We've dispatched a team to Indiana last week and to Florida this week. I'm sorry, to Indiana last week to help contain the infections and learn more about the virus. Our experience with MERS so far suggests that the risk to the general public is extremely low. It is behaving relatively like the SARS Coronavirus in that transmission requires close contact. For example, caring with someone when they're sick at home or sick in the hospital. And it involves caring for someone who is infectious with the disease. Generally when we think of the spread of infectious diseases, we look at both the individual who has the disease and the type of medical procedure that's undertaken. So certain medical procedures are higher risk than others. We're doing everything possible to find individuals who may have had contact with this person so they can be evaluated as necessary. The work that's gone on over the past couple of weeks with Indiana has really been quite extensive. The hospital, the local, the state health departments have all been very proactive and very effective at identifying people who may have been exposed, making sure that they're appropriately cared for and appropriately isolated and appropriately tested. And at this point, that testing is relatively complete, and we have not yet seen any secondary cases. So it's encouraging so far. In addition, we have sent additional staff to Saudi Arabia in conjunction with the World Health Organization to learn more about the virus including to try to understand where it comes from and what are the risk factors for acquiring it. This work is really vital because there's no way we can effectively protect Americans only by working within the U.S. borders. That's one of the reasons we focus on helping other countries find and stop emerging infections such as MERS promptly and preventing them wherever that's possible. This is one of the reasons that we've recently stepped up our efforts to improve global health protection and global health security because we really are all connected by the air we breathe, by the water we drink and by the food we eat and by the airplanes that we ride on. I'll turn the call over now to Dr. Schuchat initially to provide more details and then after Dr. Armstrong's statement, we'll be available to answer your questions.

ANNE SCHUCHAT: Thanks so much, Dr. Frieden. Let me share some more information with you about the second MERS importation into the United States. What we're doing in collaboration with the state and local authorities and a little bit about the global context. As Dr. Frieden said, the patient is a healthcare provider who resides and works in Saudi Arabia. Since March 2014, there's been a substantial increase in the number of MERS cases reported worldwide. The reason for this increase in cases is not yet completely known. However, public health investigations are ongoing. And as you heard, CDC currently does have a team in Saudi Arabia supporting those efforts. As of May 12th, 2014, a total of 538 laboratory-confirmed cases including 145 deaths due to MERS Coronavirus infection have been reported. Saudi Arabia alone has reported 450 lab-confirmed cases and 112 deaths. This second imported case of MERS that we are talking about today is not linked to the first confirmed case of MERS that was imported in the U.S. that we announced about ten days ago. So this new import is not linked with the patient that was cared for in Indiana. Let me tell you a little bit more about the second importation. On May 1st, this patient departed Jeddah, Saudi Arabia, and traveled by airplane to London, England. And then from London to Boston, Massachusetts. The patient traveled from Boston to Atlanta, Georgia, and then from Atlanta to Orlando, Florida. The patient began feeling unwell during the flight from Jeddah to London and continued to feel unwell on subsequent flights with reported symptoms including fever, chills and a slight cough. The Florida hospital is using standard contact and airborne isolation precautions to avoid exposure within the hospital and among healthcare personnel and other people interacting with the patient, as recommended by CDC. Public health and hospital officials are investigating and responding to the situation by reviewing appropriate infection control measures taken by the hospital, interviewing the healthcare staff and family members and others who had very close contact with the patient to obtain detailed information on their exposures. Collecting and testing specimens from people who had close contact with the patient and monitoring their health for relevant respiratory symptoms related to MERS Coronavirus. Conducting airline contact tracing to identify and notify U.S. travelers who may have been exposed to the U.S. imported case during that person's travel. We will also provide information to international partners on people who may have been exposed in other countries so they can do appropriate notifications. Thanks to the efforts of our Florida public health colleagues who quickly and effectively identified and began responding to this case, the number of people exposed to the patient is not as great as it might have otherwise been. Despite this second U.S. importation of MERS Coronavirus, the risk to the general public remains very low. In some countries, the virus has spread from person to person through close contact like caring for or living with an infected person. But this virus has not shown the ability to spread easily from person to person in community settings. Clusters of human-to-human spread have been seen most frequently in healthcare workers who have been caring for MERS patients. In collaboration with the Hellenic Center for Disease Control and prevention and the Hellenic Pasture Institute in Greece, and the Indiana department of health and community hospital in Indiana, we've been able to study the virus genomes so far. Comparison of these new sequences with other publicly available virus sequences does not indicate any significant changes that would explain the current increase in reported cases. CDC and these institutions submitted the sequences to Genbank to make them available to the scientific community for further testing and analysis. You'll recall that there's no vaccine to prevent MERS Coronavirus infection and that there's no specific antiviral treatment recommended for MERS. Though medical care can help relieve symptoms such as respiratory problems. CDC continues to advise people to protect themselves from respiratory infections by washing their hands often, avoiding close contact with people who are sick, avoiding touching their eyes, nose and mouth with unwashed hands, and disinfecting frequently touched surfaces. We don't know yet exactly how this MERS virus spreads, but we encourage people to take these common-sense steps. I want to talk a little bit about travel. At this time, CDC does not recommend that anyone change their travel plans. On May 2nd, CDC changed our travel notice to include enhanced precautions for travelers planning to work in the health care settings in the Arabian Peninsula and nearby countries. These travelers are advised to follow CDC's recommendations for infection control which are discussed in great detail on the CDC MERS website. All travelers to the region are advised to take general steps to protect their health such as hand washing and avoiding close contact with sick people. Travelers who develop fever and symptoms of respiratory illness like cough or shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula should call ahead to their healthcare provider and mention their recent travel. People who are sick should stay home from work or school and delay future travel to reduce the possibility of spreading illness to others. Because we are likely to have additional importations of MERS Coronavirus, we are asking health care professionals to be vigilant and value late patients for MERS corona infection. If they have fever or pneumonia or acute respiratory stress syndrome and either travel from countries in or near the Arabian Peninsula within 14 days before their symptom onset or if they've had close contact with a symptomatic traveler who developed fever and acute respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula. We also want health care providers and public health to be vigilant for clusters of patients with severe acute respiratory illness of unknown etiology so that they also can be evaluated for MERS. State and local health departments in consultation with doctors and other health care professionals will evaluate anyone who's had close contact with a confirmed or probable case. It's still very early in this investigation, and there is still much uncertainty surrounding this new respiratory virus. Including where it comes from and exactly how it spreads. So the information we tell you today and the guidance we list today on our website may change as we continue to learn more. We promise to keep you informed of significant developments. I'd like to turn it over now to Dr. John Armstrong who is Florida's state surgeon general and secretary of health so that he can provide brief remarks from the state's perspective.

JOHN ARMSTRONG: Thank you, Dr. Schuchat. This call reflects the abundance of caution with which we are working together to ensure the safety of Florida's residents and visitors. As you've heard, MERS Co-V is not easy to spread, and there is no broad risk presented to the public from this case identified in Orange County. This event reminds all of us about three ways to stay well and prevent the spread of infection. And it bears repeating. Washing your hands routinely, keeping your hands away from your eyes, nose and mouth, and staying home when sick. The Florida department of health is working directly with the hospital team that has been caring for the patient, and we will share further information from this hospital later this afternoon. We appreciate the ongoing collaboration with the CDC, the hospital and local health care professionals to ensure patient care consistent with CDC guidelines, identify contacts who may have been exposed, and reassure residents and visitors that they remain safe.

TOM FRIEDEN: Before we go to questions, just to summarize one of the key points that Dr. Schuchat made along with colleagues around the world and in Indiana, we have sequenced the Indiana patient's virus and have not seen big differences. That's important to us in public health because with the increase in reported cases from the Arabian Peninsula over the past weeks and months, one of the essential questions to ask is did the virus change? And the answer to that seems to be probably not. It doesn't appear that it has. That's reassuring. So that is consistent with what we're seeing from the Arabian Peninsula, Saudi Arabia and elsewhere which is an increased proportion of asymptomatic or more mildly symptomatic patients. In other words, we think that at least some of the increase in cases that we're hearing about from the Middle East does have to do with better monitoring and tracking. And that's a good thing. That means that we're able to find patients earlier, protect them and others from spread and get a better handle on how to stop the disease transmission.

KATHERINE LYONDANIEL: Great. Thanks, Sharon will take the first question now.

OPERATOR: Thank you. If you would like to ask a question, please press star-1 on your touch tone phone. Please unmute your phone and record your name at the prompt. Our first question comes from Peter King of CBS News. Go ahead, sir. Your line is open. Peter king, your line is open.

OPERATOR: peter king, your line is now open.

PETERKING: Hi. I'm sorry, can you hear me now?

OPERATOR: Yes.

PETER KING: It’s Peter King with CBS Radio News, and ironically, I am based here in the Orlando area where this case is. So I’ve got one question to follow up. With three flights that this health care worker took, how many people are you worried about being exposed to this, and how far along are you to tracking them down and letting them know?

TOM FRIEDEN: So we're working very actively to identify people. Let me just back up and say we don't actually know that there is a risk associated with airline travel. In other conditions sometimes we only look at flights that are more than eight hours or flights where we're only looking at someone a row or two in front or behind of the patient who had the disease. But out of an abundance of caution, we are, as we did in the Indiana case, reaching out to all of the people who can be identified. This would be in excess of 500 in this case. It's a very big job. I'll tell you that last weekend CDC staff put in over 1,000 person hours just for the weekend, not even including the state and local health department's efforts and other part of the federal government's efforts to reach people. And what we have found from that is no one so far who appears to have become infected, but we will continue to track closely out of an abundance of caution.

PETER KING: Thank you. And my follow-up-- and I realize there's a lot you can't tell us about the patient, but can you tell us-- give us whether it's a man or a woman and an age, please?

ANNE SCHUCHAT: I think that we'll defer to the hospital which will be providing additional information later. So for this particular call, we really wanted to focus on the national issue to alert folks. But I think our colleagues in Florida will be providing further data later. Remember that it's very important to protect the privacy of individuals when there are outbreak investigations ongoing. And we really respect that need.

PETER KING: We understand that. But you haven't told us what hospital yet. So that would be helpful, too.

JOHN ARMSTRONG: This is John Armstrong. We'll be sharing further information from this hospital later this afternoon.

MIRIAM FALCO: Hi there. Can you tell us if this healthcare worker working in Saudi Arabia was taking care of patients with MERS? That came up with the first patient as well and I believe in that case that wasn't the case. But in this-- did this health care worker work with patients with MERS? And also, it sounds like this patient was infectious. Can you correct me if I’m wrong since you said there were symptoms developing between London and Boston, which, of course, makes it a little scarier to some. And finally, you said that this is more like SARS in the way it is spread. In the past, the comparison to SARS has been not so strong because, of course, with SARS, you had 8,000 people sickened and almost 800 people killed. Those numbers are much lower in this particular case. I was surprised to hear that analogy unless you're only specifically talking about the close contact taking care of someone.

TOM FRIEDEN: Let me answer your third question, and Dr. Schuchat will answer your first. What I meant by that is that what we're seeing in this is a risk to people who have close contact with patients who are ill. Whether they're family members or family caregivers or people who are in hospitals particularly if infection control is not optimal. What we're not seeing in this as we did not see with SARS, except in unique events with SARS, is broader transmission in the community.

ANNE SCHUCHAT: Let me take the other two questions that you had. Our information is preliminary right now about the health care worker's exposures in Saudi Arabia, but we do believe that the patient was working in a facility that was caring for people with MERS. We don't have specific details of this individual's direct contact with MERS patients right now, but there's good collaboration between the Florida team from the county health department and the hospital and CDC, and we're following up with our colleagues who were in Saudi Arabia with the team over there. So I suspect that kind of detail will be forthcoming.

Now, you mentioned that you used the phrase “the patient was infectious while traveling.” I'd like to step back from that. We understand that the patient had some symptoms while traveling, but we really don't know whether the patient was in a state where transmission was possible. Again, as you may recall from SARS, what we saw was very limited transmission in the community, even when people had symptoms. The primary transmission was when they were very sick in the hospital with pneumonia and difficulty breathing. And so we didn't see, even with households, we saw very limited spread even when there were symptoms. So I would differentiate a mild feeling of being unwell with a clear knowledge that the patient was infectious. Again as Dr. Frieden said, it's out of abundance of caution that we want to contact everybody on all of the flights. That may help us understand whether you can spread this kind of virus when you have the type of symptoms that the person apparently had.

ALEX WAYNE: Hi, thanks. Could you just go over the latest numbers of cases and deaths worldwide? It's higher than what I had previously heard.

ANNE SCHUCHAT: Yes. Thank you. The total number is 500-- and these are based on countries reporting to WHO. They've now grouped all of those cases together. As of May 12th, 2014, there's a total of 538 laboratory-confirmed cases worldwide, including 145 deaths. Specifically for Saudi Arabia which has the majority of cases and deaths, they report 450 cases, including 118 deaths.

ALEX WAYNE: Okay, thank you.

ANNE SCHUCHAT: So these are reports based on the data that is shared by the WHO. So again, there's been an increase since March with a lot of cases reported during the month of April. And an intense set of investigations in the region and then worldwide through the WHO coordination.

LENA SUN: Hi. Thanks for taking my question. Actually, I have a couple of questions. Do we know how many U.S. residents are living and working in Saudi Arabia as these two health care workers were? And the second question is since-- when somebody comes into the U.S. and since we know that what the symptoms are, are customs folks asking questions, and when somebody has these symptoms, are they supposed to be alerting CDC or the state health departments where these people are traveling to? And finally, the third question is-- sorry-- Orlando, was this person visiting family in Orlando? What was this person doing in Orlando, site of Disney, everything? Or were they just going to Disney World?

TOM FRIEDEN: So I'll defer to the state for the last question. Though again, we really don't like to give any information that might disclose or interfere with patient confidentiality. We don't have exact numbers for the number of individuals from the U.S. who work in the region. We do know it's not rare that one of the things that Saudi Arabia and other countries often do is to have health care workers to provide care. That's not just U.S. health care workers but health care workers from around the world. So this is an issue that is relevant for the World Health Organization and relevant for many countries that have, as we do, health care professionals working in the region.

In terms of the border issues, CDC has quarantine stations at all of the major airports of entry in the U.S. If someone has symptoms, we are immediately contacted. If need be, we will go on board the plane. We do not recommend screening of people coming off. We don't find that to be productive. First off, many people who may be ill may not be identified as being ill. And second, many people who will be ill with routine colds and minor conditions would be. So we've looked at that and not found that to be something we would recommend at this time.

ANNE SCHUCHAT: We are, though, increasing the alerting in hospital-- I'm sorry, in airports and quarantine staff and customs staff have been refreshed in terms of awareness about the signs and symptoms and the approach to take. So you may, if you're traveling in the near future, see signs in the airports reminding you about reporting to your doctor if you develop respiratory symptoms with fever within 14 days of returning from affected countries. So I think we have been in close partnership with other parts of the government and the airline industry and the airports to make sure travelers have the right information at the right time.

KATHERINE LYONDANIEL: Dr. Armstrong, is there anything you'd like to add?

JOHN ARMSTRONG: This patient was visiting family and did not visit any theme parks. And we will share further information from the hospital later this afternoon.

LENA SUN: Do we know when this afternoon since it's already afternoon? Hello? Cut me off?

JOHN ARMSTRONG: We will be sharing information later this afternoon.

KATHERINE LYON DANIEL: Sharon, next question, please.

OPERATOR: Our next question comes from Mike Stobbe of AP. Go ahead, your line is open.

MIKE STOBBE: Hi. Thank you for taking my question. First I just want to clarify-- it was referenced to tracking down as many as 500 people. Were there-- how many flights, Jeddah to London, London to Boston, Boston to Atlanta, Atlanta to Orlando. So is that four separate flights that you're tracking passengers down? Also, could you tell us a little more about he landed on May 1st, but became sick on May 8th? I know you said he was visiting family, but was he in Orlando all that time, or was he traveling around the state of the country? Could you tell us a little bit more about that missing week?

ANNE SCHUCHAT: The over 500 travelers were the three flights in the United States. The Jeddah to London flight is being worked up in partnership with our UK colleagues. Those numbers will increase the total. The 500 or so is for the three flights in the U.S. My understanding is that the Florida health department is working closely with the hospital on understanding the patient's exposures during the time before the patient presented for care and that they are notifying the relatively small number of close contact had.

JOHN ARMSTRONG: The patient has remained in Orlando during his visit, and we are working with the hospital on contact identification, a small number.

TOM FRIEDEN: And I would just reiterate that we don't think there is a risk for people from casual contact here. What we have seen repeatedly with MERS, both in the Arabian Peninsula and in Europe where there have been some importations and occasionally one or two secondary cases is it has been really universally in people who have had very close contact.

DAN CHILDS: Hi. Thank you so much for taking my questions. Two quick questions. Number one, I was very interested in knowing what the nature of the correspondence is with the 500 or so people that are going to be contacted. Are they going to be told to be on the lookout for symptoms or to see their doctors for tests? What might that comprise? And the other question that I had is that we know with the first MERS patient, there was a situation where they actually-- the healthcare workers who were in contact with this patient at the hospital were looked at more closely. Is there a similar situation at the Orlando hospital in which health care workers who had been in contact with this patient are now getting either special tests or being scrutinized more closely?

ANNE SCHUCHAT: Yeah, thank you. The questions about the contacts and so forth, the airline contacts will be notified that they were on a flight with a person who had this illness. Here are the signs and symptoms that they should look out for. If they develop those signs and symptoms, they should call their clinician and let them know ahead of time about the exposure so that the right kind of precautions can be taken and that the right kind of tests can be collected. And they'll be asked to provide a specimen so that they can-- we can understand whether they might have even developed infection without even symptoms. In terms of the hospital protocols, the discussions with the state health department in Florida have really mirrored the discussions with Indiana. In terms of extra precautions for health care workers who may have been exposed prior to appropriate isolation and so that they can be monitored for symptoms and not further spread. Probably Dr. Armstrong may want to expand on that.

JOHN ARMSTRONG: So the Florida department of health has been working very closely with this hospital and is particularly mindful of health care workers who may have been exposed. And we are following standard infection control protocols, and we'll share further information from this hospital later this afternoon.

STACEY NAGGIAR: Yeah, hi. On the May 2nd telebriefing, you noted that the median age for patients getting the disease is about 51 years old. I'm wondering if there are any other characteristics that you know of to profile those who have been infected or those who have died specifically, if the deaths are already among those immune-compromised or otherwise healthy people?

ANNE SCHUCHAT: The world literature so far does point to people with underlying conditions and older people as at higher risk for fatal infections, although tragically there have been fatalities in younger individuals as well. We believe worldwide that there are about one-fifth of the reported cases that are occurring in healthcare workers. So that's really the biggest group of designated at-risk people right now. Whether the age that we're seeing is a marker for particular community exposures or the health care practitioners, we don't know. That's-- those statistics are really from the many reports that have come out of the countries with a lot of cases.

STACEY NAGGIAR: Thank you.

ANNE SCHUCHAT: In general, in these global reports, males predominate over females, but of course we have had had symptomatic and asymptomatic cases in both males and females.

KATHERINE LYON DANIEL: Did you have a follow-up?

STACEY NAGGIAR: Yes. Thank you so much. Also, the World Health Organization says that about 27 percent of cases are fatal. And I see that the CDC says about 30 percent. I'm wondering if there's a reason for the difference between those two.

TOM FRIEDEN: So basically what we're seeing is that as countries in the region do more diagnosis, we're identifying people with less severe illness. So we anticipate seeing the reported case fatality rate fall as we identify more individuals with the infection. That's kind of the usual course of events with situations like this.

STACEY NAGGIAR: Thanks very much.

KATHERINE LYON DANIEL: Thank you. Sharon, next question.

OPERATOR: Our next question comes from Julie Steenhuysen of Reuters. Go ahead. Your line is open.

JULIE STEENHUYSEN: Yeah, hi. Thanks for taking my call. I am curious to know just a little bit more detail about this healthcare worker. Do we know whether or not this person is a U.S. Citizen or a Saudi national or what? And also, you mentioned he or she travelled from Jeddah. Was the person working in a hospital in Jeddah? For example, we know a little bit about King Fahad hospital in Jeddah. Was that the hospital where this person worked?

TOM FRIEDEN: We don't know the answer to the question about his citizenship. We do know that we're working very actively both here with the Florida hospital and officials and with Saudi Arabia where we've had very good surveillance and collaboration. We have a team there now. And we're communicating so that an investigation can be done, tracing back, really, not only within this country but within Saudi Arabia as well.

JULIESTEENHUYSEN: But we don't know at what hospital this person was working at yet?

ANNESCHUCHAT: What I’d like to say is that at this stage in an investigation, information is fluid, and there's been multiple kinds of information about that question coming back. So I’d say it's still being looked into.

ROBERT LOWES: Thanks for taking my call. I have two questions. One, what is the condition of the patient? And second, what is the-- what was the state of infection control at the hospital in terms of how soon he was isolated once he was admitted? Were--was the hospital personnel quickly assume that this might be a case of MERS, a suspected case, and therefore take all the precautions quickly? Can you talk about the timetable of what was done when there?

JOHN ARMSTRONG: We are pleased with the response from the hospital to this patient reflecting on public health implications. And we're going to share further information from this hospital later this afternoon.

ROBERT LOWES: What about the condition of the patient?

TOM FRIEDEN: The patient is doing well, and the hospital responded very promptly to the situation and promptly isolated the patient.

KATHERINE LYON DANIEL: Next question, please.

OPERATOR: Our next question comes from Andrew Katz of Time Magazine. Go ahead, your line is open.

ANDREW KATZ: Yes, thanks for taking my call. I'm just wondering very quickly whether the patient's symptoms progressed significantly between feeling unwell on the flight and then when they entered the hospital.

ANNE SCHUCHAT: The information we have is that the patient only sought care right before they were admitted. So my understanding is that-- and again, the patient apparently is stable and doing well at this point.

ANDREW KATZ: Mm-hmm. Wonderful. And can you just go over the symptoms one more time and which flight they were feeling ill on?

ANNESCHUCHAT: Yeah. The information that we have-- hold on one moment-- is that, you know, as i said, the patient began feeling unwell during the flight from Jeddah to London.

ANDREW KATZ: Mm-hmm.

ANNE SCHUCHAT: continued to feel unwell on subsequent flights and eventually reported having fever, chills and a slight cough.

ANDREW KATZ: Mm-hmm.

ANN SCHUCHAT: That’s what we've heard at this time. I can tell you that in these investigations, sometimes additional information comes through. But apparently that was the story. And by the time the person arrived at their destination, they were not ill enough to seek care until later on. So that would be consistent with a feeling of unwell but not that bad.

ANDREW KATZ: Got it. Thank you very much.

KATHERINE LYON DANIEL: Thank you. Next question.

OPERATOR: Our next question comes from Kathleen Doheny of WebMD. Go ahead. Your line is open.

KATHLEEN DOHENY: Thank you. Two quick questions. How soon will the airline passengers be notified? And meanwhile, can they look up flight numbers?

ANNE SCHUCHAT: They’re being notified right now. So there are team’s making calls even as we speak. And we also are working in close collaboration with other-- with the state health departments in a number of states. I believe that 20 states are helping with this in terms of contacting the travelers who ended up in their state. So this is, as I said, a multistate, national kind of follow-up. And that is the way that we're approaching this. We're not releasing flight information. But we do have just about 20 states making calls right now and CDC helping the states who wanted assistance in that. So again, remember that the flight was on May 1st. Today is May 12th. The incubation period for MERS, we believe, is often around five days with an outer limit of 14 days. So for the traveling public, I’d like to reassure them that it is likely that if you haven't already developed symptoms, you're probably not going to. We think out of an abundance of caution, we do want to contact people who were on these planes so that we can alert them about their need to seek attention if they develop symptoms and that we can also potentially make sure they didn't develop an asymptomatic infection through some specimen collection. So I think while the calls are being made now and will go on over the next few days, i believe, we are getting towards the end of the period where we think it would be biologically possible for them to acquire infection.

KATHLEEN DOHENY: So by when do you expect that effort to be done, and meanwhile, can they look up the flight numbers?

ANNE SCHUCHAT: The effort is very intense right now. And I have no end date to it.

KATHERINE LYON DANIEL: Great. Thank you, Sharon. Next question.

OPERATOR: Our next question comes from Helen Branswell of the Canadian Press. Go ahead, your line is open.

HELEN BRANSWELL: Hi, thanks very much for taking my questions. I have a couple, please. This person worked in a hospital-- you know, MERS is very high profile in Saudi Arabia at the moment. When he realized he was unwell and needed care, did he take precautions? Did he phone the hospital in advance to tell them he was coming in and might be infected with MERS? Did he wear a mask? Did he wear masks on the flights that he was on? And the second question is-- relates to the family he was visiting. Are they in quarantine at the moment?

ANNE SCHUCHAT: Thank you, Helen, for those questions. Let me begin and then let Dr. Armstrong expand. The information that we have is that the patient became unwell while en route. So whether he or she took any precautions before boarding the plane, I really can't tell you. That the protocol that we have followed for both Indiana and Florida is that the very close contact such as household contacts will be staying home, away from others, monitoring their health until the end of the 14-day exposure period. So, you know, we think of that as voluntary home quarantine. Or if they're going out there wearing a mask, that's generally the protocol that we have described. In terms of what communication happened when the patient presented to the health care facility, I will leave that to the hospital to share.

KATHERINE LYON DANIEL: Dr. Armstrong, did you want to add anything?

JOHN ARMSTRONG: The family is currently staying at home, and to our knowledge, the patient did not wear a mask in transit. And we will provide further information from this hospital later this afternoon.

KATHERINE LYON DANIEL: Okay. I think we have time for a couple more questions. Our next question.

OPERATOR: Our next question comes from Kerry Sheridan of AFP. Go ahead, your line is open.

KERRY SHERIDAN: Hi, thanks. You mentioned that you expect there to be more cases. Can you elaborate on that? I mean, have there been some unconfirmed cases yet in the United States? And also, I’m wondering, why don't you publish the flight information for the general public so that they could just check and see quickly if they were on the flight?

TOM FRIEDEN: So for the first question in terms of the number of cases, since we are seeing clusters in Saudi Arabia and elsewhere in hospitals, and since there are health care workers traveling back and forth, we would not be surprised to see additional cases just as we have not been surprised by these cases. We also know that there may be increased travel in the months to come for some of the holidays. In terms-- in fact, we've already ruled out well over 150 people who came in with symptoms, but out of an abundance of caution, we tested and found them to be negative. We have identified these two cases, identified by local hospitals and collaboration with their local health department and state health department using CDC test kits, but we've also had, again, over 150 other travelers tested with CDC test kits who have been found negative. So we're basically saying that we would not be surprised to see additional cases. We're not predicting that there will be. In terms of the flight information, we have good information on the individuals who traveled, and we feel that at this point the best way to do that is to contact them directly.

PHILIP VICTOR: Hi. So of the 145 people that you said have died so far, is that from the beginning of this year or 2012, and also do we know how many have been health care workers, and do you have any concerns about healthcare workers who treated either these two patients in the U.S. or for healthcare workers who will be treating any additional cases we'll see here in the U.S.?

ANNE SCHUCHAT: You know, the information on 450 cases and 118 deaths is since 2012. So since the first recognition of the virus. I don't have the number of healthcare workers' deaths. But the number of healthcare worker cases is approximately one-fifth. And there have been many deaths among those. This is a relatively new virus that is very severe. We take it very seriously. And that's why we're taking these extra precautions both for healthcare workers traveling to the Arabian Peninsula and with the appropriate isolation and personal protective equipment for health care workers here. We think it's very important for health care workers in the U.S.to be alert and aware of this, take special precautions, be in good contact with their health departments for partnership and how to evaluate, follow up on cases. This is not a virus that we can treat right now with specific antivirals, and we think that excellent infection control is absolutely critical.

TOM FRIEDEN: So I’d like to just make a couple of concluding remarks. I'd thank everyone for being part of the call, reiterate here is what we've seen is the second confirmed case of MERS Coronavirus in the U.S. this is unwelcome but not unexpected. What we're seeing is the importance of two key concepts here when it comes to Coronavirus, particularly MERS at this point. The first is the need for meticulous infection control in hospitals. And what has been done in Indiana and is being done in Florida is exactly what's needed to minimize the risk of spread. Rapid detection of a patient who's infected, rapid isolation and appropriate isolation of that individual, and then a furlough of other health care workers who have had contact with that individual and who may become ill so that if they become ill, they will not create another chain of transmission. So the first major issue to get right in the response to MERS is meticulous infection control. The second issue is not overreacting in society generally. We are not seeing widespread transmission. We're not seeing casual transmission. So while we continue to learn more and will continue to make available all of the information we know about the virus and how it spreads, this does not present a risk to the general public, but it does have the twin risks of making sure that we're fully responding appropriately in health care facilities, and we're not doing things that are counterproductive or not useful in other settings. I want to thank everyone very much for joining us.

KATHERINE LYON DANIEL: Thank you once again for joining us today. A transcript of this briefing will be available on the CDC media relations website as soon as possible. If you need additional information, please call the CDC media relations office at 404-639-3286. This concludes our call. Thank you.

OPERATOR: This concludes the conference for today. Please disconnect at this time.